Urge the Senate to act on prior auth reform today!
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The prior authorization approval process, now more than ever, consumes valuable physician and staff time, costs physician practices money, and may negatively impact patients by delaying much-needed treatment.
One in every three people with Medicare is enrolled in a Medicare Advantage (MA) plan. Under current law, MA plans may not create inappropriate barriers to care that do not already exist within the original Medicare program. However, physicians are reporting that MA plans have imposed increasingly onerous prior authorization requirements for medical services and procedures that are impacting patient access to medically necessary care. AGA and other physician organizations are advocating for regulatory changes related to how MA plans use prior authorization.
The Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S. 3018), which was introduced by Reps. Suzan DelBene, D-WA, Mike Kelly, R-PA, Ami Bera, MD, D-CA, and Larry Bucshon, MD, R-IN, in the House and by Sens. Roger Marshall, MD, R-KS, Krysten Sinema, D-AZ, and John Thune, R-SD, in the Senate, is legislation that aims to increase transparency and streamline the prior authorization process in the Medicare Advantage program by:
- Establishing an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities;
- Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program;
- Standardizing and streamlining the prior authorization process for routinely approved items and services; Ensuring prior authorization requests are reviewed by qualified medical personnel;
- Increasing transparency around MA prior authorization requirements and their use; and
- Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
On September 14th, the House passed H.R. 3173, the Improving Seniors Timely Access to Care Act of 2021, with strong bipartisan support. It is imperative that the Senate consider H.R. 3173 before the conclusion of the 117th Congress.
Urge your Senator to bring H.R. 3173 to the Senate Floor today!
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